Write three headings in your notes: clinical recommendation, facility decision, and insurer decision. Under the first, record what a qualified professional recommends and the date of that recommendation. Under the second, record whether the facility is reviewing the person, what information it still needs, and whether availability has been confirmed. Under the third, record whether authorization is required, whether a request has been received, and whether the answer is pending, approved, partially approved, or denied.
For Living Longer Recovery, keep a status box beside every facility-specific statement. Mark “confirmed” only for information verified directly for your situation. Mark “needs review” for current availability, individual fit, admission, room type, staffing, schedule, medications, and insurance participation. Mark “not established” when no reliable answer has been provided. The public record supports only the legal identity, address, record number, 14-person capacity, co-ed adult population, residential drug and alcohol detox, and incidental medical services. It does not turn an insurance conversation into an admission decision.
- What exact service is the qualified professional asking the plan to review?
- Does the insurer recognize the facility and service under the same names?
- Is prior authorization required before admission, after admission, or at another point defined by the plan? What exact deadline applies? For alcohol detox, do not delay emergency.